• Features of antenatal ultrasonographic monitoring and perinatal outcomes for monochorionic multiple pregnancy specific anomalies 

Features of antenatal ultrasonographic monitoring and perinatal outcomes for monochorionic multiple pregnancy specific anomalies 

PERINATOLOGIYA I PEDIATRIYA. 2016.2(66):77-85; doi 10.15574/PP.2016.66.77 

Features of antenatal ultrasonographic monitoring and perinatal outcomes for monochorionic multiple pregnancy specific anomalies 

Safonova I.

Kharkovskaya National Medical Academy of Postgraduate Education, Ukraine 

The purpose was to study the differential features of ultrasonographic (US) monitoring and perinatal results with various specific complications of monochorionic (MC) multiple pregnancy. 

Design — single-center prospective cohort observational study. 

Material and methods. US studies were conducted in 246 women with multiple pregnancies, including 134 with multichorionic type and 112 with MC type of multiple pregnancy. MC pregnancies had the following options: 101 MC twins; 10 MC triplets; 1 MC quadruplets. Postnatal results were classified as follows: adverse general postnatal outcome (GPO) meant perinatal or infant death; adverse clinical postnatal outcome (CPO) meant severe neonatal morbidity. 

Results. In 73/112 patients (65%) with MC multiple pregnancy some US features and sequences of changes were observed. 15 women had twin-to-twin transfusion syndrome (TTTS), 9 of them had the chronic uncorrected TTTS and 6 were under observation before and after in8utero treatment; 3 women had acute inter-twin transfusion (AITT); in 1 case there was anemia-polycythemia sequence (TAPS); selective fetal growth retardation (sFGR) was detected in 28 cases and after single intrauterine death 7 MC and 8 multichorionic pregnancies were monitored. The most unfavorable GPO were in unimproved TTTS, and the most unfavorable CPO were in sFGR. AITT did not have any specific antenatal predictors. Abnormal Doppler by type of intermittent absent umbilical artery flow in MC pregnancy were difficult to interpret and were accompanied by a moderately increased risk of adverse GPO and CPO (OR 1.88; 1.64–2.09 while 95% CI). So it is extremely difficult to evaluate the degree of perinatal risk in such a form of US monitoring of МС multiple pregnancy. 

Conclusions. Such specific anomalies of MC multiple pregnancy as TTTS, TAPS and sFGR have some similar US manifestations but different perinatal prognosis and require different tactics. Antenatal monitoring, including fetometry, amniometry and Doppler aspects as well as comparison of twin's bladders and hearts sizes, and study of their umbilical cords structure, allows to predict the degree of perinatal risk in MC multiple pregnancy. 

Key work: multiple pregnancy, ultrasonographic monitoring, Doppler, perinatal results. 


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